Ripples of Change

As part of our Gaun Yersel! stories, Jane Holt reflects on ten years of the Self Management Strategy for Scotland.

There has been an unprecedented amount of change in how our health service is working: we have more people living longer, multimorbidity is the new normal, and we now have Health and Social Care Partnerships designed to shift the balance of care for acute hospitals to communities.

Hi-tech care is sexy and portrayed by the media in so many programmes like 24 hours in A&E. By contrast, although self management may not be viewed a fast or sexy, it is fundamental in giving people back a life worth living.

Despite working in an era of savings and financial scrutiny, if you put your head above the parapet, there are opportunities out there. For our team it was the Integrated Care Fund. We saw there was money available to work differently. Before, we were simply a cardiac rehab team, but we had a vision. If we could be a multimorbidity team we could increase access and availability to rehabilitation and self management for more people affected by long term conditions.

Did it make sense? Yes. Was there evidence for it? No.

We created HARP (Healthy and Active Rehabilitation Programme) for people affected by multiple long term conditions. Its approach embraces supported self management.

Under our new model, we wanted to work with a wider range of people other than cardiologists, specialist teams and people like “us”, important as these people are. We wanted to work with the Third sector, service users, Health and Social Care Partnerships, and link workers. We wanted seamless transitions with leisure services as well as shared training and meetings. This means that our new services are based in local communities in rural and deprived areas.

We are trying new activities with our service users like walking football, all ability cycling, and guest lecturing at further education events. We don’t think that we have to have all the answers, but we can help people to find their local solutions.

Building in peer support

In our previous world, we used to meet as medical professionals who always had to have the answers. It has been a total eye opener to see our service users come back as volunteers in our classes. They provide peer support, a realistic role model, and a lived experience. Our service users find them inspirational. Our activity friend volunteers have become valued team members and we wouldn’t want to work without them. They are the icing on our cake.

Living with chronic conditions – who cares?

The modern world can be a lonely place. Many of our service users describe a life where in the past they were living at home and did not go out. They felt they had lost their role as mum, brother, worker, or friend because they thought of themselves as an ill person. They had ruled out life through fear of making their medical conditions worse.

Rehabilitation with medical expertise, peer support, physical activity, information, hints and tips all contribute to finding a new normal. Good quality self management programmes with clinical expertise should be available for all people in local communities using co-productive principles to empower individuals and collectives.

Are we there yet? No. We are in our fourth year of building an evidence base, we are working with pots of funding, and awaiting secure posts for staff. But it is a blast and an adventure, and we aim to secure and embed this work not just locally, but to have it given the national importance it deserves. Not for me or for just a few people, but for all the multitude of people out there who are overwhelmed by their own health conditions and who need a helping hand. Working together we can make ripples of change.

“Individually, we are one drop. Together, we are an ocean.” Ryunosuke Satoro

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